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外科内镜真空治疗术在上消化道吻合口漏和穿孔中的应用。

Surgical endoscopic vacuum therapy for anastomotic leakage and perforation of the upper gastrointestinal tract.

机构信息

Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057 Rostock, Germany.

出版信息

J Gastrointest Surg. 2012 Nov;16(11):2145-50. doi: 10.1007/s11605-012-2014-3. Epub 2012 Sep 5.

Abstract

INTRODUCTION

Emergency operations for perforations and anastomotic leakage of the upper gastrointestinal tract are associated with a high overall morbidity and mortality rate. An endoscopic vacuum therapy (EVT) has been established successfully for anastomotic leakage after rectal resection but only limited data exist for EVT of the upper GI tract.

METHODS

We report on a series of nine patients treated with EVT for defects of the upper intestinal tract between March 2011 and May 2012. In four patients, initial endoscopic sponge placement was performed in combination with open surgical revision. Median follow-up was 189 (range, 51-366) days.

RESULTS

In total, 52 vacuum sponges were placed in upper GI defects of nine patients. Indication for EVT were anastomotic leakage after esophageal resection or gastrectomy (n = 5) and iatrogenic or spontaneous esophageal perforations (n = 4). The mean number of sponge insertions was six (range, 1-13) with a mean changing interval of 3.5 days (range, 2-5). A successful vacuum therapy for upper intestinal defects was achieved in eight of nine patients (89 %).

CONCLUSION

EVT is a promising approach for postoperative, iatrogenic, or spontaneous lesions of the upper GI tract. If necessary the endoscopic procedure can be combined with operative revision for better control of the local septic focus.

摘要

简介

上消化道穿孔和吻合口漏的急诊手术与高整体发病率和死亡率相关。直肠切除术后吻合口漏的内镜真空治疗(EVT)已成功确立,但仅存在有限的数据支持 EVT 治疗上消化道。

方法

我们报告了 2011 年 3 月至 2012 年 5 月期间 9 例采用 EVT 治疗上消化道缺陷的患者系列。在 4 例患者中,最初进行内镜海绵放置联合开放手术修正。中位随访时间为 189 天(范围,51-366 天)。

结果

总共在 9 例患者的上消化道缺陷中放置了 52 个真空海绵。EVT 的适应证为食管切除术后或胃切除术后吻合口漏(n=5)和医源性或自发性食管穿孔(n=4)。插入海绵的平均数量为 6 个(范围,1-13),平均更换间隔为 3.5 天(范围,2-5)。9 例患者中有 8 例(89%)成功地进行了上消化道缺陷的真空治疗。

结论

EVT 是治疗上消化道术后、医源性或自发性病变的一种有前途的方法。如果需要,内镜程序可以与手术修正相结合,以更好地控制局部感染焦点。

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